Provider Demographics
NPI:1144473695
Name:PELLICCIA, MARIA L (SLP)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:L
Last Name:PELLICCIA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WILLOWBROOK TER
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2647
Mailing Address - Country:US
Mailing Address - Phone:518-421-2891
Mailing Address - Fax:
Practice Address - Street 1:49 WILLOWBROOK TER
Practice Address - Street 2:
Practice Address - City:HALFMOON
Practice Address - State:NY
Practice Address - Zip Code:12065-2647
Practice Address - Country:US
Practice Address - Phone:518-421-2891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist